Situated entirely within the Appalachian region, West Virginia (WV) is characterized by a rural and socioeconomically disadvantaged population with a health status of citizens among the worst in the country. In 2006 (Phase I), the West Virginia Collaborative Health Outcomes Research of Therapies and Services (WV CoHORTS) Center was established with the mission to stimulate multi-disciplinary health services and outcomes research, and to provide the infrastructure necessary for scientists to collaborate on research projects at West Virginia University Health Sciences Center (WVUHSC). The CoHORTS Center has established itself as the primary center for growing health services and outcomes research at WVUHSC, and is an integral component of the newly established Clinical and Translational Sciences Institute. The long-term goal of this Center is to establish a center of excellence that stimulates ongoing, rigorous research in health services and outcomes that will focus on reducing health disparities and improve the overall health of the citizens of WV. In Phase II, the Center will: 1) create a data repository of state and federal healthcare data to serve as a resource and catalyst for the conduct of health services and outcomes research in WV;2) develop collaborative relationships that brings together health services researchers to stimulate multidisciplinary research;and 3) establish a mentoring program for junior faculty investigators to become more competitive for federally funded grants in health services and health outcomes research. Apart from growing the infrastructure, three research projects will be completed in Phase II. Project 1 will establish a Medicare-Medicaid-Cancer Registry dataset to determine the burden of breast, colorectal, lung, and prostate cancers in WV. Project 2 will address the critical need to develop and implement smoking cessation interventions for cancer patients following diagnosis, and engage health providers to assist with cessation efforts. Finally, Project 3 will pilot test an activity-focused intervention to determine appropriate activity expectations for patients undergoing total hip or knee replacement due to arthritis. At the end of Phase II funding, we expect to have developed a sustainable infrastructure that supports research on the economic, clinical, and humanistic outcomes related to health services utilization and treatments of chronic diseases specific to WV and rural Appalachia. We expect to build capacity by increasing the number of health services researchers at WVU. All of the studies will ultimately lead to R01 or other large grant applications to AHRQ, NIH, or CDC. The proposed Medicare-Medicaid-Cancer Registry linked dataset will be a vital resource for cancer researchers to understand, intervene, and reduce cancer disparities in WV. The CoHORTS Center will become a model for other rural and medically underserved states in the conduct of research that reduce health disparities, enhance the use of cost-effective health services, and improve the quality of healthcare.